| Tuberculosis (TB) - An infectious bacterial disease | | | | employer shall furnish to each employee a place of |
| transmitted through the air that mainly affects the | | | | employment which is free from recognized hazards |
| lungs. | | | | that cause or are likely to cause death or serious |
| With rare exceptions, TB is infectious only when it | | | | physical harm & each employee shall comply |
| occurs in the lungs or larynx. TB that occurs | | | | with the occupational safety & health standards |
| elsewhere in the body is usually not infectious, unless | | | | and all rules, regulations and orders issued pursuant to |
| the person also has TB in the lungs or larynx at the | | | | this Act which are applicable to his own actions and |
| same time. | | | | conduct.” Additionally, OSHA requires |
| According to the Centers for Disease Control and | | | | employers with employee exposure to TB must |
| Prevention (CDC), an estimated 2 billion persons (i.e., | | | | comply with certain requirements including: 1910.134 - |
| one third of the world's population) are infected with | | | | Respiratory Protection, 1910.145 - Accident |
| M. tuberculosis. Tuberculosis kills almost 1.6 million | | | | Prevention Signs and Tags, and 1904 – |
| people per year. Although the 2007 TB rate (4.4 | | | | Recordkeeping. |
| cases per 100,000 population) was the lowest | | | | Under the General Duty Clause, OSHA will issue |
| recorded in the United States since national reporting | | | | citations to employers with employees working in |
| began in 1953, the average annual decline has slowed | | | | one of the workplaces where the CDC has identified |
| since 2000. TB is now the second most common | | | | workers as having a higher incidence of TB infection |
| cause of death from infectious disease in the world | | | | than the general population, when the employees are |
| after human immunodeficiency virus/acquired | | | | not provided appropriate protection and who have |
| immunodeficiency syndrome (HIV/AIDS). | | | | exposure as defined below: |
| Characteristics of persons exposed to M. tuberculosis | | | | Exposure to the exhaled air of an individual with |
| that might affect the risk for infection are not well | | | | suspected or confirmed pulmonary TB disease, |
| defined. The probability that a person who is | | | | Or |
| exposed to M. tuberculosis will become infected | | | | Employee exposure without appropriate protection to |
| depends primarily on the concentration of infectious | | | | a high hazard procedure performed on an individual |
| droplet nuclei in the air and the duration of exposure | | | | with suspected or confirmed infectious TB disease |
| to a person with infectious TB disease. The closer | | | | and which has the potential to generate infectious |
| the proximity and the longer the duration of | | | | airborne droplet nuclei. |
| exposure, the higher the risk is for being infected. | | | | Furthermore: OSHA will issue citations under the |
| Additional hazards are now present because of | | | | "General Duty Clause" in cases where the |
| multidrug-resistant (MDR) TB. MDR organisms are | | | | following procedures are not followed: |
| resistant to the drugs that are normally used to treat | | | | Periodic Evaluations: TB skin testing shall be |
| TB, such as Isoniazid and Rifampin. The course of | | | | conducted every three (3) months for workers in |
| treatment when treating MDR TB increases from 6 | | | | high risk categories, every six (6) months for |
| months to 18-24 months, and the cure rate | | | | workers in intermediate risk categories, and annually |
| decreases from nearly 100% to less than 60%. | | | | for low risk personnel. The CDC has defined the |
| Mortality among patients with MDR-TB can be high. | | | | criteria for high, intermediate, and low risk categories. |
| TB disease in persons over the age of 65 constitutes | | | | When working with TB potential hazards, OSHA |
| a large proportion of TB cases in the United States. | | | | recommends the prompt implementation of early |
| Many of these individuals have latent TB infection; | | | | screening procedures, and staff training to help them |
| however, with aging these individuals' immune | | | | identify potentially infectious individuals, which will |
| function starts to decline, placing them at increased | | | | allow for early identification of patients with infectious |
| risk of developing active TB disease, and employees | | | | TB and the initiations of appropriate controls before |
| in long-term care facilities at risk of occupational | | | | occupational exposure occurs to staff and other |
| exposure to TB. Nursing homes or long-term care | | | | patients. |
| facilities for the elderly have been identified as having | | | | OSHA encourages employers to follow the guidelines |
| a high-risk situation for the transmission of TB. The | | | | established by the Centers for Disease Control and |
| degree of risk of occupational exposure of a worker | | | | Prevention (CDC), Division of Tuberculosis Elimination |
| to TB will vary based on a number of factors. | | | | (DTBE) to minimize the potential of TB transmission. |
| OSHA withdrew its 1997 proposed standard on | | | | Should TB exposure occur, OSHA Directive CPL 2.106 |
| Occupational Exposure to Tuberculosis because it is | | | | states individuals with suspected or confirmed |
| unlikely to result in a meaningful reduction of disease | | | | infectious TB disease must be placed in a respiratory |
| transmission caused by contact with the most | | | | acid-fast bacilli (AFB) isolation room. High hazard |
| significant remaining source of occupational risk: | | | | procedures on individuals with suspected or confirmed |
| exposure to individuals with undiagnosed and | | | | infectious TB disease must be performed in AFB |
| unsuspected TB. | | | | treatment rooms, AFB isolation rooms, booths, and |
| Although OSHA has no standard for TB Infection | | | | or hoods. (AFB isolation refers to a negative pressure |
| Control, it will enforce the “General Duty | | | | room or an area that exhausts room air directly |
| Clause” in situations where employers' failure | | | | outside or through HEPA filters if recirculation is |
| to implement available precautions exposes workers | | | | unavoidable). |
| to the hazard of TB infection. Created under the | | | | OSHA requires all healthcare settings establish a TB |
| Occupational Safety & Health Act of 1970, the | | | | infection control program designed to ensure prompt |
| General Duty Clause can be thought as an | | | | detection, airborne precautions, and treatment of |
| employer’s general responsibility to ensure the | | | | persons who have suspected or confirmed TB |
| safety of all its employees and states: “Each | | | | disease. |